Purpose To evaluate the long-term local control, failure patterns, and toxicities after individualized clinical target volume (CTV) delineation in unilateral nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). Methods Unilateral NPC was defined as a nasopharyngeal mass confined to one side of the nasopharynx and did not exceed the midline. From November 2003 to December 2017, 95 patients were retrospectively included. All patients received IMRT. The CTVs were determined based on the distance from the gross tumor. The contralateral para-pharyngeal space and skull base orifices were spared from irradiation. Results There were three local recurrences and eight regional recurrences in 10 patients during an 84-month follow-up. All local recurrences were within PGTVnx, and all in-field recurrences. No recurrences were found in traditional high-risk areas including contralateral the para-pharyngeal space and skull base orifices. The 10-year local-recurrence-free survival, regional-recurrence-free survival and overall survival were 96.2%, 90.5% and 84.7%, respectively. The dosimetry parameters of the tumor-contralateral organs were all lower than the values of the tumor-ipsilateral side (P < 0.05). The late toxicities occurred mainly in the tumor-ipsilateral organs, including radiation-induced temporal lobe injury, impaired visuality, hearing loss and subcutaneous fibrosis. Conclusion Individualized CTV delineation in unilateral NPC could yield excellent long-term local control with limited out-of-field recurrences, reduced dose to tumor- contralateral organs and mild late toxicities, which is worthy of further exploration.

6523 Background: Based on an individual patient data (IPD) network meta-analysis (NMA) of 20 randomized trials and 5,144 patients (pts), the MAC-NPC collaborative group has shown that the addition of adjuvant chemotherapy (AC) to chemo-radiotherapy (CRT) achieved the highest survival benefit in nasopharyngeal carcinoma (NPC; Ribassin-Majed JCO 2017). Here, we updated the meta-analysis with the addition of 8 trials. Methods: Trials of Radiotherapy (RT) with or without chemotherapy (CT) in patients with non-metastatic NPC were identified and updated IPD obtained. Both Western and Chinese medical literatures were searched. Overall Survival (OS) was the main endpoint. Fixed and random-effects frequentist NMA models were applied, network heterogeneity and consistency were evaluated. P-score was used to rank the treatments. R software - netmeta package was used to perform the analyses. Treatments were grouped in the following categories: RT alone (RT), induction chemotherapy followed by RT (IC-RT), induction chemotherapy without taxanes followed by concomitant chemoradiotherapy (ICtax(-)-CRT), induction chemotherapy with taxanes followed by concomitant chemoradiotherapy (ICtax(+)-CRT), concomitant chemoradiotherapy (CRT), concomitant chemoradiotherapy followed by adjuvant chemotherapy (CRT-AC) and RT followed by adjuvant chemotherapy (RT-AC). Results: Overall 28 trials and 8,214 pts were included. Median follow-up was 7.2 years. There was no heterogeneity in the NMA. There was inconsistency in the main analysis, which disappeared after the exclusion of 2 outlier trials. ICtax(+)-CRT ranked the best treatment for OS with a P-Score of 91%. Hazard ratio [HR, 95% Confidence Interval] for ICtax(+)-CRT was 0.75 [0.59-0.96] compared to CRT and 0.92 [0.69-1.24] compared to CRT-AC (second best treatment in raking with a P-Score of 85%; see league table below). When the 2 types of IC were merged, CRT-AC ranked the first followed by IC-CRT with P-Scores of 93% and 86% respectively, with a HR of 0.97 [0.84-1.14] for CRT-AC vs. IC-CRT. Conclusions: This IPD NMA of the treatment of locally advanced NPC demonstrates that the addition of IC or AC to CRT improves disease control probability and survival over CRT alone. Data on progression-free survival, locoregional and distant control will be presented at the meeting. [Table: see text]

6022 Background: In a previous MAC-NPC individual patient data (IPD) meta-analysis, the addition of chemotherapy (CT) to radiotherapy improved overall survival (OS) in nasopharyngeal carcinoma (NPC; Baujat IJROBP 2006). There was an interaction between the timing of CT and treatment effect, with an OS benefit restricted to the concomitant (+/- adjuvant) timing. Since other trials have been conducted, this meta-analysis was updated. Methods: Trials of radiotherapy (RT) with or without CT in patients with non-metastatic NPC were identified and updated IPD obtained. Both Western and Chinese medical literatures were searched. OS was the main endpoint. The fixed-effect model was used. All analyses were pre-specified. Results: Overall 19 trials and 4,798 pts were included. One 2x2 trial was counted twice and 5,020 pts were analyzed. Patients characteristics were well balanced (60% < 50 years, 75% male, 60% PS 0, 90% stage III-IV and 96% WHO grade 2-3). Median follow-up was 7.1 years. There was a significant benefit in favor of CT regarding OS (hazard ratio (HR) [95% confidence interval]: 0.79 [0.72;0.86], p <0.0001; absolute benefit at 5 years=6.4%). There was a significant interaction between treatment effect on OS and the timing of CT (p=0.01) in favor of concomitant CT (without adjuvant CT: HR 0.79 [0.68;0.92]; with adjuvant CT: HR 0.65 [0.56;0.76]) compared to induction CT (HR 0.96 [0.80;1.16]) or adjuvant CT (HR 0.93 [0.70;1.24]), which explained the statistical heterogeneity. Restriction of the analysis to trials with a control arm with RT alone led to similar results. The benefit of the addition of CT was consistent for all endpoints: progression-free survival (HR 0.76 [0.70;0.82], p<0.0001), loco-regional control (HR 0.74 [0.65;0.85], p<0.0001), distant control (0.68 [0.60;0.76], p<0.0001) and NPC related mortality (0.73 [0.66;0.81], p<0.0001). There was no significant interaction between treatment effect on OS and patient covariate (age, sex, tumor stage). Conclusions: The addition of concomitant chemotherapy, with or without adjuvant CT, significantly improves survival in patients with locally advanced nasopharyngeal carcinoma. Supported by PHRC and LNCC

目的:鼻咽癌是我国常见恶性肿瘤之一,其中肺转移是其治疗失败的主要原因之一,鼻咽癌肺转移的治疗尚无统一标准.外科手术治疗肺转移瘤已取得初步成效,但仍不尽如人意.通过对23例鼻咽癌肺转移瘤患者行手术治疗的结果进行回顾性研究,探讨影响其预后的因素.方法:回顾性分析23例鼻咽癌肺转移瘤行手术治疗的患者,分别对无瘤生存时间、肿瘤大小、个数、手术方式、辅助治疗、临床分期等因素对总生存率的影响行单因素分析,并对以上因素行Cox回归多因素分析.结果:本组患者均有完整随访资料,其1、2、3、5年生存率分别为95.7%、65.2%、56.5%、21.7%.中位生存时间50.8个月.患者无瘤生存时间的长短与患者的生存率相关(P=0.026);转移灶个数、直径大小、手术方式(OPEN或VATS)、肺楔形/肺段切除术与肺叶切除术、是否行肺门纵隔淋巴结清扫及术后辅助放/化疗与患者的总体生存率无统计学相关性(P>0.05);手术治疗后再次发生远处转移的患者占52.2%,其生存率明显降低(P=0.014),Cox回归分析OR=5.512,P=0.029.结论:外科手术治疗是鼻咽癌肺转移的一种治疗手段,无瘤生存时间的长短是影响外科手术治疗鼻咽癌肺转移预后的因素之一,而手术治疗失败的主要原因为再次发生远处转移.